Thrombotic Events in MIS-C Patients: A Single Case Report and Literature Review

Multisystem Inflammatory Syndrome in Children (MIS-C) is a systemic hyperinflammatory disorder that is associated with a hypercoagulable state and a higher risk of thrombotic events (TEs). We report the case of a 9-year-old MIS-C patient with a severe course who developed a massive pulmonary embolis...

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Published in:Children (Basel) Vol. 10; no. 4; p. 618
Main Authors: Maniscalco, Valerio, Niccolai, Rachele, Marrani, Edoardo, Maccora, Ilaria, Bertini, Federico, Pagnini, Ilaria, Simonini, Gabriele, Lasagni, Donatella, Trapani, Sandra, Mastrolia, Maria Vincenza
Format: Journal Article
Language:English
Published: Switzerland MDPI AG 25.03.2023
MDPI
Subjects:
Anticoagulants
Apixaban
Blood clot
Care and treatment
Case Report
Case reports
Coronaviruses
COVID-19
disability
heparin
Literature reviews
Medical research
Medicine, Experimental
MIS-C
Multisystem inflammatory syndrome in children
Pediatrics
prophylaxis
Pulmonary embolism
Risk factors
Thrombosis
Veins & arteries
heparin
MIS-C
thrombosis
prophylaxis
disability
ISSN:2227-9067, 2227-9067
Online Access:Get full text
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Summary:Multisystem Inflammatory Syndrome in Children (MIS-C) is a systemic hyperinflammatory disorder that is associated with a hypercoagulable state and a higher risk of thrombotic events (TEs). We report the case of a 9-year-old MIS-C patient with a severe course who developed a massive pulmonary embolism that was successfully treated with heparin. A literature review of previous TEs in MIS-C patients was conducted (60 MIS-C cases from 37 studies). At least one risk factor for thrombosis was observed in 91.7% of patients. The most frequently observed risk factors were pediatric intensive care unit hospitalization (61.7%), central venous catheter (36.7%), age >12 years (36.7%), left ventricular ejection fraction <35% (28.3%), D-dimer >5 times the upper limit of normal values (71.9%), mechanical ventilation (23.3%), obesity (23.3%), and extracorporeal membrane oxygenation (15%). TEs may concurrently affect multiple vessels, including both arterial and venous. Arterial thrombosis was more frequent, mainly affecting the cerebral and pulmonary vascular systems. Despite antithrombotic prophylaxis, 40% of MIS-C patients developed TEs. Over one-third of patients presented persistent focal neurological signs, and ten patients died, half of whom died because of TEs. TEs are severe and life-threatening complications of MIS-C. In case with thrombosis risk factors, appropriate thromboprophylaxis should be promptly administered. Despite proper prophylactic therapy, TEs may occur, leading in some cases to permanent disability or death.
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ISSN:2227-9067
2227-9067
DOI:10.3390/children10040618